Epidural Chloroma and Spinal Cord Compression

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Epidural Chloroma and Spinal Cord Compression: A Case of Misdiagnosis and Rapid Neurologic Decline in a Chronic Myeloid Leukemia Patient

Did you know some people with leukemia can develop rare solid tumors that squeeze the spinal cord? For a 68-year-old man with chronic myeloid leukemia (CML), this rare complication led to sudden paralysis—and a warning for patients and doctors alike about the need to spot unusual cancer signs.

What Is Chloroma?

Chloroma (or granulocytic sarcoma) is a rare tumor made of malignant myeloid blast cells—the same cells that cause myeloid leukemia. Unlike leukemia, which affects the blood and bone marrow, chloroma grows outside the hematopoietic (blood-forming) system. It can appear almost anywhere: the head, bones, breasts, uterus, or even the central nervous system. For leukemia patients, chloroma often shows up as an epidural mass (a tumor around the spinal cord) that presses on nerves, causing back pain, leg weakness, or worse—spinal cord compression.

The Case: A Man’s Journey From Back Pain to Paralysis

The patient, a 68-year-old from China with no other major health issues, was diagnosed with CML at Seoul St. Mary’s Hospital in 2015. His diagnosis was confirmed by bone marrow tests showing the BCR-ABL1 gene (a key marker for CML) and a chromosomal abnormality (t(9;22)). He took the targeted drug nilotinib to control his leukemia.

Months later, he developed severe low back pain and leg numbness. A CT scan suggested mild disc degeneration and bulging discs—common causes of back pain. His doctors treated him with caudal epidural blocks (injections to reduce nerve inflammation) and sacroiliac joint steroids. His pain dropped from 9/10 to 3/10, and he could walk without a cane.

Six months later, the pain returned. He’d gone back to work as a construction worker, and his symptoms worsened: leg weakness, numbness, and now trouble moving his legs. Doctors repeated the epidural blocks and added transforaminal steroid injections (targeted at specific spinal nerves). But just four days later, he could barely move his legs. He also couldn’t urinate or control his bowels—a red flag for spinal cord damage.

An emergency MRI revealed the truth: a tumor (chloroma) in the epidural space of his lower thoracic spine (T11–T12) was compressing his spinal cord. The team rushed him into surgery for a total laminectomy (removing part of the spine to relieve pressure) and tumor removal. Frozen tissue samples confirmed chloroma—a solid mass of CML cells growing outside his bone marrow.

Treatment and Outcome

The patient got steroids and radiation therapy (to kill remaining tumor cells) after surgery. But his paralysis didn’t improve. He refused bone marrow transplantation and was discharged to a local hospital for ongoing care 35 days later.

Key Lessons From This Case

This story holds critical lessons for anyone with leukemia—and the doctors who treat them:

  1. Chloroma Is a Hidden Risk for Leukemia Patients
    Chloroma is rare, but it’s more common in people with myeloid leukemia (like CML or acute myeloid leukemia). If you have leukemia and develop progressive leg weakness, numbness, or bowel/bladder problems, don’t ignore it—these could be signs of spinal cord compression from chloroma.

  2. MRI Is Your Best Diagnostic Tool
    The patient’s initial CT scan missed the chloroma because it looked like a disc problem. MRI is far better at spotting soft-tissue tumors like chloroma. For leukemia patients with new neurologic symptoms, an MRI should be a top priority.

  3. Early Recognition Saves Function
    The patient’s symptoms progressed from back pain to paralysis in days. If doctors had suspected chloroma earlier—when he first had recurring pain—they might have done an MRI sooner. Rapid treatment (surgery + radiation) is key to preserving movement, but it’s not always enough if the tumor has already damaged the spinal cord.

  4. Patient Education Matters
    The man didn’t know that bowel/bladder trouble was a emergency. If he’d been told to seek help immediately for those symptoms, doctors could have acted faster. Leukemia patients should learn to recognize “red flag” signs: weakness that gets worse quickly, trouble urinating, or loss of bowel control.

What This Means for You

If you or someone you love has leukemia:

  • Track your symptoms: Keep a log of back pain, numbness, or weakness—especially if they get worse.
  • Ask about chloroma: If you have new neurologic symptoms, ask your doctor if chloroma could be the cause.
  • Don’t wait for “worse”: Bowel/bladder problems or sudden weakness are emergencies—go to the ER right away.

This case was reported by Hyun Jung Koh, Jungwon Baek, Min Soo Lee, and Hue Jung Park from the Department of Anesthesiology and Pain Medicine at Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea. The patient gave informed consent for his case to be published.

References

  1. Buckland ME, et al. Spinal chloroma presenting with triplegia in an aleukaemic patient. Pathology. 2001;33:386–389. doi: 10.1080/00313020126312
  2. Kao SC, et al. Intracranial granulocytic sarcoma (chloroma): MR findings. J Comput Assist Tomogr. 1987;11:938–941. doi: 10.1097/00004728-198711000-00003
  3. Krause JR. Granulocytic sarcoma preceding acute leukemia: a report of six cases. Cancer. 1979;44:1017–1021.
  4. Landis DM, et al. Granulocytic sarcoma: an unusual complication of aleukemic myeloid leukemia causing spinal cord compression. Leuk Lymphoma. 2003;44:1753–1760. doi: 10.1080/1042819031000104051
  5. Ripp DJ, et al. Granulocytic sarcoma presenting as an epidural mass with cord compression. Neurosurgery. 1989;24:125–128.
  6. Kellie SJ, et al. Extradural chloroma with spinal compression – an unusual presentation of acute myelogenous leukemia. Aust N Z J Med. 1984;14:160–162.
  7. Sung CH, et al. Clinical experience of pain management of lower leg pain due to chloroma of lumbosacral bone in chronic myelogenous leukemia. Korean J Pain. 1989;2:61–65.
  8. Wong MC, et al. Occult epidural chloroma complicated by acute paraplegia following lumbar puncture. Ann Neurol. 1992;31:110–112. doi: 10.1002/ana.410310121

doi.org/10.1097/CM9.0000000000000081

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